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Chiropractic Research Review

NSAIDs and Aspirin: Painkillers or Patient-Killers?

Prolonged bleeding time and gastrointestinal distress are two of the most well-known side-effects of nonsteroidal anti-inflammatory drugs and aspirin. If used in conjunction with other drugs that increase bleeding time, the incidence of bleeding complications associated with NSAIDs is also likely to increase.

Exactly how much NSAID and aspirin use contribute to gastrointestinal problems (or deaths caused by such problems) remains a matter of debate, however.

To determine the incidence of mortality associated with hospital admissions due to gastrointestinal events and NSAID or aspirin use, researchers in Spain conducted an observational study, using data on patient deaths from two other studies. The first study evaluated data on 26 Spanish general hospitals on hospitalizations due to gastrointestinal events, peptic ulcers, or complications such as bleeding or perforation, along with drug use in the month before hospitalization in patients who died. The second study contained information on hospital stays due to GI events, the severity of those events, and associated costs. In both studies, the vast majority of patients were age 60 or older.

Results: In the first study, 8,010 serious gastrointestinal events were reported; among these patients, the mortality rate was 5.72 percent. In the second study, 50,114 serious GI events were reported, with a resultant mortality rate of 5.62 percent. Extrapolating the data from both studies to the entire Spanish population, the researchers estimated that "the proportion of complications and deaths attributed to NSAID/aspirin use was 36.3%." When the number of complications and deaths were calculated based on the type of NSAID used, low-dose aspirin was found to be "responsible for no less than 8.25 and no more than 12.2% of all complications and deaths." They also found that the data "translate into a mortality rate as a consequence of NSAID/aspirin-related GI complications ... of 21.0-24.8 cases per million inhabitants," which, based on current NSAID use by the Spanish adult population, would equate to up to 15.3 deaths for every 100,000 users of aspirin or NSAIDs.

The authors stated that their study highlights the importance of taking steps "to research new and better alternatives to treat pain and inflammation in the elderly, to heighten physician and public awareness of the associated problems of NSAID therapy, and to educate them on the use of appropriate prevention strategies." They added that gastrointestinal events related to NSAID and aspirin use "pose an important problem to the national health of any country with respect to loss of life and utilization of health care resources."

Lanas A, Perez-Aisa MA, Feu F, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. American Journal of Gastroenterology, August 2005;100:1685-1693.

Chiropractic Research Review

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